Definition

Rate of newly reported cases of primary and secondary syphilis by date of diagnosis per 100,000 persons.

Numerator

Number of newly reported cases of primary and secondary syphilis by date of diagnosis.

Denominator

Utah's total population.

Data Interpretation Issues

Reported primary and secondary syphilis rates are calculated by dividing the number of cases within the population of interest by the total number of persons within that population, then multiplying by 100,000. It should be noted that because of the relatively small number of primary and secondary syphilis infections reported in Utah, rates can be volatile: a small change in the number of cases can noticeably change the rate. This change may look significant, but, statistically, it may not be. Caution is strongly recommended when interpreting small case numbers and rates.

Why Is This Important?

Syphilis is a complex sexually transmitted disease (STD) caused by the bacterium ''Treponema pallidum'' (spp. ''pallidum''). The initial stage (primary syphilis) is characterized by a highly infectious painless open sore, called a chancre, at the site of infection. Chancres occur mainly on the external genitals, vagina, anus, or in the rectum. Syphilis is passed from person to person through direct contact with the chancre. Sexual transmission can also occur during the secondary stage of syphilis. An infant can acquire syphilis through the placenta if the mother is infected.
In later stages of the disease, the bacteria move throughout the body, damaging many organs over time. The open nature of the syphilitic sores makes it easier to acquire HIV, if exposed, or to transmit the virus, if infected. Public health intervention and education measures are crucial in eliminating syphilis.

Healthy People Objective STD-7:

Reduce sustained domestic transmission of primary and secondary syphilisU.S. Target: Not applicable, see subobjectives in this category

How Are We Doing?

In 2017, 117 cases of primary and secondary (P&S) syphilis were diagnosed and reported in Utah. Forty-six of the cases were primary syphilis and seventy-one cases were secondary syphilis. The rate for P&S syphilis in 2017 was 3.7 cases per 100,000 persons, a 23.3% increase from the rate of 3.0 cases per 100,000 persons reported in 2016. P&S syphilis rates have increased from 2006 until 2017, with decreases in 2011 and 2014, 78.3% and 38.0% respectively.
During 2017, 88.0% of P&S syphilis cases were diagnosed among residents within the Wasatch Front (Salt Lake, Davis, Utah, and Weber Counties); which is consistent with recent years. Salt Lake County Health District had the highest rate of P&S syphilis at 7.6 cases per 100,000 persons.
P&S syphilis cases were primarily diagnosed among men during 2017 at a rate of 7.2 per 100,000 male persons. Males between the ages of 20-24 years actually experienced the highest rates in 2017 (18.5 cases per 100,000 people). Only four females were diagnosed with P&S syphilis in 2017. Only 32 females have been reported with P&S syphilis from 2000-2017.
During 2017, the P&S syphilis cases were diagnosed primarily among White, non-Hispanic individuals (65.8%) followed by Hispanics (19.7%).

How Do We Compare With the U.S.?

P&S syphilis rates in Utah have consistently been lower than rates in the U.S., although Utah has experienced several increases in recent years.
The overall 2017 rate for P&S syphilis in the U.S. was 9.5 cases per 100,000 persons, compared to 8.6 cases per 100,000 in 2016. Nationally in 2017, rates were highest among males aged 25 to 29 (51.9 cases per 100,000 persons). Males had a significantly higher rate than females: 16.9 cases per 100,000 males as compared to 2.3 cases per 100,000 females (CDC. [http://www.cdc.gov/std/stats17/default.htm ''Sexually Transmitted Disease Surveillance''], 2017).

What Is Being Done?

Persons who test positive for syphilis are confidentially interviewed by a local public health nurse to educate the patient, ensure proper treatment, and to obtain sexual partner information for follow-up. This process potentially prevents those diseases reported from being spread and from the patient becoming reinfected. The Centers for Disease Control and Prevention recommendations for testing, treatment, and follow-up are adhered to by the Utah Department of Health and the local health departments.
The Utah Department of Health Communicable Disease Prevention Program, along with local health departments, currently provides STD presentations upon request to a variety of organizations, agencies, and facilities.

Available Services

The Utah Minor's Consent Law allows adolescents between the ages of 14 and 17 years to be tested and treated for an STD without the consent of a parent. Therefore teens are able to utilize clinics available to them confidentially.
Many local health districts have STD clinics located at their local health department where adolescents can be tested and treated for STDs at minimal or no cost. Planned Parenthood has locations throughout Utah that also provide STD services at minimal cost. Condoms are also available at these locations.
STD presentations are available through the Utah Department of Health upon request. The Utah Department of Health also has educational pamphlets available.

Related Indicators

Relevant Population Characteristics

The vast majority (88.0%) of P&S cases are diagnosed among residents within the Wasatch Front (Salt Lake, Davis, Utah, and Weber Counties). In 2017, Salt Lake County Health District had the highest rate of P&S syphilis at 7.6 cases per 100,000 persons.
In 2017, P&S syphilis cases were primarily diagnosed among men (96.6%), with men aged 20 to 24 experiencing the highest rate of P&S syphilis (18.5 cases per 100,000 persons). The majority of cases (65.8%) were White, non-Hispanic.

Related Health Care System Factors Indicators:

Risk Factors

Risk factors for sexually transmitted diseases include:
* sexual activity among young adults 25 and younger
* multiple sex partners
* prior history of STDs
* unprotected sex
* sexual contact with prostitutes (male or female)
* illicit drug use[[br]]
[[br]]
Those who fall within one or more of these categories should be tested for STDs in regular intervals. Sites of primary syphilis infection may include penis, rectum, anus, vagina, cervix, vulva, or mouth.

Related Risk Factors Indicators:

Health Status Outcomes

Elimination of syphilis will aid in the fight against HIV, as the open nature of the syphilitic sores makes it easier to acquire HIV, if exposed, or to transmit the virus, if infected. Public health intervention and education measures are crucial in eliminating syphilis.

Data Notes

Rates were calculated by dividing the number of cases within a race/ethnicity group by the population in that group and multiplying by 100,000.

Data Sources

Utah Department of Health, Bureau of Epidemiology

Population Estimates by Age, Sex, Race, and Hispanic Origin for Counties in Utah, U.S. Bureau of the Census, IBIS Version 2017

Primary and Secondary Syphilis by Local Health District, Utah, 2017

Local Health District

Cases per 100,000 Persons

Record Count: 15

Bear River

1.1

Central

0.0

Davis County

1.4

Salt Lake County

7.6

San Juan

0.0

Southeast

2.5

Southwest

3.4

Summit

0.0

Tooele

1.5

TriCounty

1.8

Utah County

1.3

Wasatch

0.0

Weber-Morgan

1.5

State of Utah

3.7

U.S.

9.5

Data Sources

Utah Department of Health, Bureau of Epidemiology

Population Estimates: National Center for Health Statistics (NCHS) through a collaborative agreement with the U.S. Census Bureau, IBIS Version 2017

National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention

References and Community Resources

Fact sheets for communicable diseases may be found on the Bureau of Epidemiology website [http://health.utah.gov/epi/diseases/syphilis/factsheet.pdf].
Other STD resources are available on the Bureau of Epidemiology website [http://health.utah.gov/epi/prevention/].
Centers for Disease Control and Prevention, Division of Sexually Transmitted Diseases Prevention website [http://www.cdc.gov/std].
Centers for Disease Control and Prevention. Sexually Transmitted Diseases Screening & Treatment Guidelines 2015 [http://www.cdc.gov/std/treatment].

More Resources and Links

Evidence-based community health improvement ideas and interventions may be found at the following sites:

Utah DOH

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